5/6/1997 - Laserfiche WebLink

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i Joseph Bobrowskas, a retired Indian River County Sheriffs Department employee, introduced his wife, Sandy. Sandy Bobrowskas advised they are currently living in North Carolina. When the County's hospital plan was changed, they received a Florida directory of drug stores and doctors. She called Personnel Director Ron Baker to find out where they could go in North Carolina and Mr. Baker advised that the prescription coverage did not apply in North Carolina, even though Rite Aid, their local pharmacy, is on the list in Florida. They would need to mail in their prescriptions. They were also advised that the $15 co -pay would apply as long as their physician is listed in the Georgia, Tennessee and North Carolina directory. When claims were subsequently filed, Mr. and Mrs. Bobrowskas started getting bills from the doctors for additional amounts of money. They called Blue Cross and were told that the co -pay does not apply when you live out of state. They feel they are not getting the same benefits as other retirees and believe they should have reduced premiums if they are to get reduced benefits. Mr. Bobrowskas also expressed dissatisfaction with the way the matter was handled by Mr. Baker and subsequently by Mr. Chandler, to whom they complained about Mr. Baker's responsiveness. The Commissioners questioned Mr. Baker and Mr. Chandler regarding the coverages and how many retirees might be affected. County Administrator Chandler stated that the plan is essentially the same as was afforded by Acordia and that there are approximately 20 retirees living out of state who are affected by these same conditions. Mr. Thomas of Blue Cross/Blue Shield explained that Blue Cross/Blue Shield organizations are each a separate organization and that the level of benefits for retirees living out of state would be the same as a dependent child attending school out of state or an employee traveling out of state. As far as the question of the balances being billed to Mr. and Mrs. Bobrowskas, if they are being treated by physicians belonging to the providers network then the balance would be written off. If the physicians are not participating providers, then the balances would be the patients' responsibility. Connie Hall, of The McCall Agency, felt this is simply a misunderstanding. Should any of the Commissioners or any other employees go outside of the State of Florida, the same benefits would apply as are being applied to Mr. and Mrs. Bobrowskas. Shelley Spevac of -Blue Cross advised that the 80120 benefit applies to any non- participating provider. Blue Cross contracts with 19,000 doctors and 80 plus or minus hospitals. If you go to any one of them, the higher benefit would apply. If you go to any provider not in the network, there is a $200 deductible and a 20-% co -payment. MAY- X97 72 =